title: Cardiopulmonary resuscitation with chest compressions during sustained inflations: a new technique of neonatal resuscitation that improves recovery and survival in a neonatal porcine model.
abstract: BACKGROUND
  Guidelines on neonatal resuscitation recommend 90 chest compressions (CCs) and 30 manual inflations (3:1) per minute in newborns. The study aimed to determine whether CC s during sustained inflations (SIs) improves the recovery of asphyxiated newborn piglets in comparison with coordinated 3:1 resuscitation.
  
  
  RESULTS
  Term newborn piglets (n=8/group) were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by asphyxia. Piglets were randomly assigned to receive either 3:1 resuscitation (3:1 group) or CCs during SIs (SI group) when the heart rate decreased to 25% of baseline. Piglets randomly assigned to the SI group received SIs with a pressure of 30 cm H2O for 30 s. During the SI, CCs at a rate of 120/min were provided. SI was interrupted after 30 s for 1 s before a further 30-s SI was provided. CCs were continued throughout SIs. CCs and SI were continued until the return of spontaneous circulation. Continuous respiratory parameters, cardiac output, mean systemic and pulmonary artery pressures, and regional blood flows were measured. Mean (standard deviation) time for return of spontaneous circulation was significantly reduced in SI group versus 3:1 group (32 [11] s versus 205 [113] s, respectively). In the SI group, administration of oxygen and epinephrine was significantly lower, whereas minute ventilation and exhaled CO2 were significantly increased. The SI group had significantly higher mean systemic and pulmonary arterial pressures during resuscitation in comparison with the 3:1 group (51 [10] versus 31 [5] mm Hg; 41[7] versus 31 [7] mm Hg, respectively; all P<0.05), with improved cardiac output and carotid blood flow.
  
  
  CONCLUSIONS
  Combining CCs and SIs significantly improved the return of spontaneous circulation with better hemodynamic recovery in asphyxiated newborn piglets in comparison with standard coordinated 3:1 resuscitation.
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada (G.M.S., MO., T.-F.L., P.-Y.C.); Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada (G.M.S., M.O., S.C., S.Q., P.-Y.C.); Department of Pediatrics, Medical University Graz, Graz, Austria (G.M.S.); Department of Surgery, University of Alberta, Edmonton, Alberta, Canada (J.L., D.L.B., P.-Y.C.); and Faculty of Science, University of Alberta, Edmonton, Alberta, Canada (S.C.).
authors.forename: Georg M
authors.initials: GM
authors.lastname: Schmölzer
authors.forename: Megan
authors.initials: M
authors.lastname: O'Reilly
authors.forename: Joseph
authors.initials: J
authors.lastname: Labossiere
authors.forename: Tze-Fun
authors.initials: TF
authors.lastname: Lee
authors.forename: Shaun
authors.initials: S
authors.lastname: Cowan
authors.forename: Sharon
authors.initials: S
authors.lastname: Qin
authors.forename: David L
authors.initials: DL
authors.lastname: Bigam
authors.forename: Po-Yin
authors.initials: PY
authors.lastname: Cheung
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001237:Asphyxia / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D035641:Chest Wall Oscillation / Q000379:methods*; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D007327:Insufflation / Q000379:methods; D011897:Random Allocation; D020127:Recovery of Function / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013552:Swine; D013997:Time Factors
keywords: cardiopulmonary resuscitation; chest wall oscillation; infant, newborn; ischemia; resuscitation